Abstract
BackgroundStigmatization and poor social support are challenges faced by individuals living with HIV or sexually transmitted disease, which can have a profound negative impact on their healthcare. Mother-to-child transmission of either HIV or syphilis can lead to adverse maternal and fetal outcomes. The aim of this study was to investigate stigmatization and social support of pregnant women with HIV or syphilis in eastern China.MethodsThis was an explanatory sequential mixed-method study conducted in Zhejiang province, China in 2019. Stigmatization, social support, and the associated factors toward HIV or syphilis were evaluated using questionnaires. The social support rating scale was used to evaluate social support, where a score <25% was defined as poor social support. A logistic regression model was used to explore the association between stigmatization and poor social support.ResultsA total of 448 women (HIV positive, N = 93; syphilis, N = 355) were recruited in this study. Higher stigmatization was observed in pregnant women with HIV compared to those with syphilis (53.76% vs. 24.36%, p < 0.001), and poorer social support was observed in women with HIV compared with those with syphilis (40.86% vs. 19.86%, p < 0.001), with significant distributions of the total social support scores (Z = −1.976, p = 0.048) and scores on objectivity (Z = −2.036, p = 0.042) and subjectivity (Z = −2.500, p = 0.012). Similar social support among HIV or syphilis pregnant women was observed in medical healthcare facilities. In multivariable logistic model analysis, stigmatization (ORadj = 2.927; 95%CI, 1.714–4.996; p < 0.001) and ethnic minority (ORadj = 2.373; 95%CI, 1.113–5.056; p = 0.025) were negatively associated with social support. Interestingly, employment status was associated with improved social support (ORadj = 0.345; 95%CI, 0.180–0.662; p = 0.001).ConclusionStigmatization among pregnant women with HIV or syphilis remains high. We demonstrated that stigmatization was a significant predictor of low social support in pregnant women with HIV or syphilis. The support shown in medical facilities was similar toward pregnant women with HIV or syphilis. Implementation of stigmatization eradication and social support strategies targeting pregnant women with HIV or syphilis may therefore improve the dual elimination of mother-to-child transmission service.
Highlights
Mother-to-child transmission (MTCT) of either HIV or syphilis is strongly associated with stillbirth, preterm birth, low birth weight, neonatal death, and congenital infection in infants [1, 2]
HIV-positive women were more likely to be from a floating population, a minority, and were more likely to be diagnosed after the first trimester relative to women with syphilis infection
Local residents accounted for 52.39% of women with syphilis, the minority proportion was only 9.30%, and the majority was identified in the first trimester
Summary
Mother-to-child transmission (MTCT) of either HIV or syphilis is strongly associated with stillbirth, preterm birth, low birth weight, neonatal death, and congenital infection in infants [1, 2]. People living with HIV (PLWH) face internalized or overt stigmatization, such as being ashamed of HIV infection, being the subject of malignant gossip, and being discriminated against in their living settings [5–8]. Studies on HIV-related stigmatization were primarily conducted in a high HIV prevalence or poor resource setting; few studies have been conducted to explore syphilis-related stigmatization in pregnant women [16]. Stigmatization associated with poor social support can lead to psychological distress, which may constitute a barrier to the implementation of EMTCT services [16, 19, 20]. Social support was revealed to be insufficient to improve health in PLWH who experienced HIV-related stigmatization [6].
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